NPI age
20 years
Enumerated 2005-06-10
Across 7055 active pediatrics providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 130892609 | |
| 01 (TX) | J3202 | STATE LI |
| 01 (TX) | 110010 | MEDICARE |
Part of a multi-provider practice. 37 other active providers share this practice address in NPPES.
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